Form EPC-016-2018-01 "Application to Construct a Dock" - Orange County, Florida

What Is Form EPC-016-2018-01?

This is a legal form that was released by the Environmental Protection Division - Orange County, Florida - a government authority operating within Florida. The form may be used strictly within Orange County. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 23, 2019;
  • The latest edition provided by the Environmental Protection Division - Orange County, Florida;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form EPC-016-2018-01 by clicking the link below or browse more documents and templates provided by the Environmental Protection Division - Orange County, Florida.

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Download Form EPC-016-2018-01 "Application to Construct a Dock" - Orange County, Florida

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A
C
D
PPLICATION TO
ONSTRUCT A
OCK
(In Accordance with Orange County Code Chapter 15, Article IX, Orange County Code)
Mail or
Orange County Environmental Protection Division
Deliver To:
3165 McCrory Place, Suite 200
Orlando, Florida 32803
(407) 836-1400, Fax (407) 836-1499
**Filing fee of $119.00 pa yable to The Board of County Commissioners**
**Process fee for Appeals and Variances: $409.00**
SECTION 1
OWNER(S) OF THE LAND
Name: ____________________________________________________________________________________________________
Title and Company: ___________________________________________________________________________________________
Address:____________________________________________________________________________________________________
City:
______________________________
State:
______________________
Zip:
_________________
Telephone and Fax: ___________________________________Email:___________________________________________________
ENTITY TO RECEIVE PERMIT ( IF OTHER THAN OWNER)
Name: ____________________________________________________________________________________________________
Title and Company: ___________________________________________________________________________________________
Address:____________________________________________________________________________________________________
City: ___________________________________________________________________________State: _______ Zip: ___________
Telephone and Fax: ____________________________________Email:__________________________________________________
AGENT/CONSULTANT AUTHORIZED TO SECURE PERMIT
Name: ____________________________________________________________________________________________________
Title and Company: ___________________________________________________________________________________________
Address:
____________________________________________________________________________________________________
City: ___________________________________________________________________________State: _______ Zip: ___________
Telephone and Fax: ____________________________________Email:_________________________________________________
CONTRACTOR (IF DIFFERENT FROM AGENT)
Name: ____________________________________________________________________________________________________
Title and Company: ___________________________________________________________________________________________
Address: ____________________________________________________________________________________________________
City: ___________________________________________________________________________State: _______ Zip: ___________
Telephone and Fax: ____________________________________Email:__________________________________________________
Page 1 of 4
Revised 09-23-2019
EPC-016-2018-01
A
C
D
PPLICATION TO
ONSTRUCT A
OCK
(In Accordance with Orange County Code Chapter 15, Article IX, Orange County Code)
Mail or
Orange County Environmental Protection Division
Deliver To:
3165 McCrory Place, Suite 200
Orlando, Florida 32803
(407) 836-1400, Fax (407) 836-1499
**Filing fee of $119.00 pa yable to The Board of County Commissioners**
**Process fee for Appeals and Variances: $409.00**
SECTION 1
OWNER(S) OF THE LAND
Name: ____________________________________________________________________________________________________
Title and Company: ___________________________________________________________________________________________
Address:____________________________________________________________________________________________________
City:
______________________________
State:
______________________
Zip:
_________________
Telephone and Fax: ___________________________________Email:___________________________________________________
ENTITY TO RECEIVE PERMIT ( IF OTHER THAN OWNER)
Name: ____________________________________________________________________________________________________
Title and Company: ___________________________________________________________________________________________
Address:____________________________________________________________________________________________________
City: ___________________________________________________________________________State: _______ Zip: ___________
Telephone and Fax: ____________________________________Email:__________________________________________________
AGENT/CONSULTANT AUTHORIZED TO SECURE PERMIT
Name: ____________________________________________________________________________________________________
Title and Company: ___________________________________________________________________________________________
Address:
____________________________________________________________________________________________________
City: ___________________________________________________________________________State: _______ Zip: ___________
Telephone and Fax: ____________________________________Email:_________________________________________________
CONTRACTOR (IF DIFFERENT FROM AGENT)
Name: ____________________________________________________________________________________________________
Title and Company: ___________________________________________________________________________________________
Address: ____________________________________________________________________________________________________
City: ___________________________________________________________________________State: _______ Zip: ___________
Telephone and Fax: ____________________________________Email:__________________________________________________
Page 1 of 4
Revised 09-23-2019
EPC-016-2018-01
SECTION 2 - GENERAL INFORMATION
Street Address: _________________________________________________________________________________ ____
Tax Parcel ID _____ - _____ - _____ - _______ - _____ - _____
Legal Description: ___________________________________________________________________________________
Name of water body:
__________________
Normal High Water Elevation (NHWE):
____________msl
Is the proposed dock? Please check one:
Private
Semi-Private
Public
What is the width of the shoreline (in linear feet), as measured at the NHWE? ___________feet.
What is the size of proposed terminal platform? _____________ square feet. [See Chapter 15; Article IX; Section 15-342(b)]
Are you requesting a variance?
Yes
No
Are you requesting a waiver?
Yes
No
If yes, provide section Number: 15-__________ (example: 15-321) and describe the nature of the variance and/or waiver request:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Note applications for a waiver and/or variance from the boat dock ordinance will require the completion of a separate waiver and/or variance
application and may require additional fees. If you have questions, please call EPD for assistance.
Brief Description of proposed work: _________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Are there docks on the abutting properties?
Yes
No
Are there any access restrictions to the property (locked gate/loose dogs):_________________________________________
REQUIRED ATTACHMENTS CHECKLIST:
Satisfactory evidence of title. (Example: copy of property deed).
Documentation showing riparian rights for the parcel, such as any legal instrument indicating ownership to the shoreline.
A copy of a survey of the real property which accurately depicts current conditions.
A copy of a site plan depicting the exact location of the proposed dock, and shall include the following:
An arrow indicating the northerly direction of the scale to which the sketch or drawing was prepared.
The name of the water body upon which the proposed dock structure or renovation is to be located .
The exact distance between the shoreline, at the point where the dock is to be constructed or is currently located, and
a permanent object or marker to be used as a reference point.
The exact setback distance from adjacent property lines and projected property lines to all portions of the dock.
The floor and roof elevations of the proposed or existing dock.
The current water depth at the end of the proposed or existing dock, and at all proposed mooring locations.
The length of the proposed or existing dock, as measured from the NHWE to the point most waterward of the NHWE.
The NHWE as established by the county and field verified by a professional surveyor.
Page 2 of 4
Revised 09-23-2019
EPC-016-2018-01
The location of any conservation easement areas and wetlands within twenty feet from any portion of the dock.
A description of vegetation types identified occurring within twenty feet from any portion of the dock.
The location of any lifts, hoists, mooring pilings and mooring areas.
A mitigation plan offsetting adverse impacts to the conservation easement areas or wetlands (if applicable).
A description of sedimentation and erosion control measures used during construction and/or repair of the dock.
Depict and label the projected property lines.
 Chapter 2019-165, Florida Statutes (House Bill 7103), establishes timeframes for applicant and agency responses. By checking
this box, you are providing written authorization for EPD to waive the mandatory timeframes established by law.
___________________________________________________________________________________________________________
PERSON AUTHORIZING ACCESS TO THE PROPERTY MUST COMPLETE THE FOLLOWING:
I either own the property described in this application or I have legal authority to allow access to the property and I consent
to any site visit on the property by agents or personnel from Orange County, Florida necessary for the review and
inspection of the proposed project specified in this application. I authorize these agents or personnel to enter the property
as many times as may be necessary to make such review and inspection. Further, I agree to provide entry to the project
site for such agents or personnel to monitor permitted work if a permit is granted.
_____________________________________________________________________________________________
Typed/Printed Name
Signature
Date
____________________________________________________________
Corporate Title (if applicable)
By signing and submitting this application form, I am applying for the permit identified above, according to the supporting
data and other incidental information filed with this application. I am familiar with the information contained in this
application, and represent that such information is true, complete, and accurate. I understand this is an application and
not a permit, and that work conducted prior to approval is a violation. I understand that this application and any permit
issued pursuant thereto, does not relieve me of any obligation for obtaining any other required federal, state, water
management district or local permit prior to commencement of construction. I understand that Orange County will make
no representation as to the proposed dock’s impact on navigability or safety. For that reason, I understand that it may be
advisable for me to consult with an expert in navigability and safety issues. I agree, or I agree on behalf of my corporation,
to operate and maintain the permitted system unless the permitting agency authorizes transfer of the permit to a responsible
operation entity; I understand that knowingly making any false statements or representation in this application is a
violation of Sections 15-341 & 15-342, Orange County Code.
Typed/Printed Name of Applicant _______________________________________________________
Signature of Applicant/Agent _____________________________________Date__________________
________________________________________
Corporate Title (if applicable)
NOTICE TO APPLICANTS: The proposed dock structure may require a permit from either the Florida Department of Environmental Protection or
the applicable Water Management District. In addition to public regulations which Orange County enforces, be advised that there may be other private
restrictions or approval requirements that will affect your ability to erect this structure. Please review your deed restrictions and/or consult with your
Homeowner’s Association or Architectural Review Board.
Page 3 of 4
Revised 09-23-2019
EPC-016-2018-01
Page 4 of 4
Revised 09 23 2019
EPC 016 2018 01
AGENT AUTHORIZATION FORM
FOR PROJECTS LOCATED IN ORANGE COUNTY, FLORIDA
I/
,
(
)
WE
PRINT
PROPERTY
OWNER
NAME
_________________________________________,
(
)
AS THE OWNER
S
OF THE REAL
,
PROPERTY
DESCRIBED
AS
FOLLOWS
_____________________________________________________,
DO
HEREBY
/
(
),
AUTHORIZE
TO
ACT
AS
MY
OUR
AGENT
PRINT
AGENT
S
NAME
____________________________________,
TO EXECUTE ANY PETITIONS OR OTHER
DOCUMENTS NECESSARY TO AFFECT THE APPLICATION APPROVAL REQUESTED AND MORE
, ___________________________________________,
SPECIFICALLY DESCRIBED AS FOLLOWS
AND TO APPEAR ON
/
MY
OUR BEHALF BEFORE ANY ADMINISTRATIVE OR LEGISLATIVE BODY IN THE COUNTY CONSIDERING THIS APPLICATION
.
AND TO ACT IN ALL RESPECTS AS OUR AGENT IN MATTERS PERTAINING TO THE APPLICATION
Date:___________
______________________________
________________________
Signature of Property Owner
Print Name Property Owner
Date:___________
______________________________
________________________
Signature of Property Owner
Print Name Property Owner
Date:___________
______________________________
________________________
Signature of Property Owner
Print Name Property Owner
Date:___________
______________________________
________________________
Signature of Property Owner
Print Name Property Owner
STATE OF FLORIDA
COUNTY OF____________
I certify that on __________________, before me, ___________________, an officer duly authorized by the State
of
Florida
and
in
the
county
mentioned
above,
to
take
acknowledgements,
personally
appeared
_____________________, to me known to be the person described in this instrument or to have produced
_______________________, as evidence, and who has acknowledged before me that he or she executed the
instrument and did / did not take an oath.
Witness my hand and official seal in the county and state stated above on the _____ day of _____________, in
the year __________.
______________________________________
Signature of Notary Public
Notary Public for the State of Florida
(Notary Seal)
My Commission Expires:
____________________
Legal Description(s) or Parcel Identification Number(s) are required:
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